How much rates vary
Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.
Rates by insurance carrier
| Insurance Carrier | Facility/Professional | Modifier | Typical Low | Median | Typical High |
|---|---|---|---|---|---|
Aetna Setting Facility Modifier None Typical Low $1,412.54 Median $1,412.54 Typical High $2,630.27 | Facility | None | $1,412.54 | $1,412.54 | $2,630.27 |
Aetna Setting Professional Modifier None Typical Low $1,479.11 Median $1,513.56 Typical High $1,513.56 | Professional | None | $1,479.11 | $1,513.56 | $1,513.56 |
CareSource Setting Professional Modifier None Typical Low $1,737.80 Median $1,737.80 Typical High $1,737.80 | Professional | None | $1,737.80 | $1,737.80 | $1,737.80 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $34.67 Typical High $2,454.71 | Facility | None | $34.67 | $34.67 | $2,454.71 |
Cigna Setting Professional Modifier None Typical Low $1,412.54 Median $2,290.87 Typical High $6,918.31 | Professional | None | $1,412.54 | $2,290.87 | $6,918.31 |
United Setting Facility Modifier None Typical Low $151.36 Median $660.69 Typical High $870.96 | Facility | None | $151.36 | $660.69 | $870.96 |
United Setting Professional Modifier None Typical Low $1,096.48 Median $1,412.54 Typical High $2,344.23 | Professional | None | $1,096.48 | $1,412.54 | $2,344.23 |
6 more rates with less common billing modifiers
A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.
| Insurance Carrier | Facility/Professional | Modifier | Typical Low | Median | Typical High |
|---|---|---|---|---|---|
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $741.31 Median $758.58 Typical High $758.58 | Professional | 52 · Reduced service | $741.31 | $758.58 | $758.58 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $295.12 Median $302.00 Typical High $302.00 | Professional | 53 · Discontinued | $295.12 | $302.00 | $302.00 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,096.48 Median $1,148.15 Typical High $1,148.15 | Professional | 54 · Surgery only | $1,096.48 | $1,148.15 | $1,148.15 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $223.87 Median $229.09 Typical High $229.09 | Professional | 55 · Aftercare only | $223.87 | $229.09 | $229.09 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $147.91 Median $151.36 Typical High $151.36 | Professional | 56 · Pre-op care only | $147.91 | $151.36 | $151.36 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,023.29 Median $1,071.52 Typical High $1,071.52 | Professional | 78 · Unplanned return to OR | $1,023.29 | $1,071.52 | $1,071.52 |
Where West Virginia sits
The same service costs 5.2 times more in Alaska than in Texas. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.
West Virginia· 33rd of 51
$1,622
Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.